The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Hypoalbuminemia and the Higher Risk of Perioperative Sentinel Adverse Events in Patients Undergoing Total Shoulder Arthroplasty: A Propensity Score Matched Analysis

Document Type : RESEARCH PAPER

Authors
Micheal Raad
Matthew J. Best
Davis Rogers
Rachel Bronheim
Suresh K. Nayar
Varun Puvanesarajah
Majd Marrache
Uma. Srikumaran
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
10.22038/abjs.2021.60229.2976
Abstract
Background: The purpose of this study is to examine the effect of hypoalbuminemia (HA) on sentinel adverse events
after total shoulder arthroplasty (TSA).
Methods: Patients who underwent primary TSA from 2015-2018 were collected from the National Surgical Quality
Improvement Program (NSQIP) database. Patients with HA (serum albumin < 3.5 g/dL) were compared to patients with
normal serum albumin. A probit regression model was used to estimate a propensity score. Logistic regression was
performed to evaluate the effect of HA on sentinel adverse events after surgery.
Results: A total of 4,337 patients were included, 8.2% of patients had HA. Patients with HA had higher rates of
sentinel adverse events (14.0% vs 5.5%, P<0.01) compared with patients who had normal serum albumin. Reoperation
(4.5% vs 1.5%, P<0.01), readmission (11.2% vs 3.9%, P<0.01), urinary tract infection (0.8% vs 0.03%, P<0.01) and
pulmonary embolism (1.1% vs 0.2%, P=0.01) were higher in patients with HA. The odds ratio for a sentinel event for
patients with HA was 2.6 (95% CI: 1.54, 4.44, P<0.01) when compared to a propensity score-matched control group.
Conclusion: Patients with HA are at increased risk of sentinel adverse events following TSA compared to patients with
normal serum albumin levels.
Level of evidence: II
Keywords
Adverse events
Albumin
Hypoalbuminemia
Shoulder arthroplasty
  1. Busher JT. Serum albumin and globulin. In: Clinical methods: the history, physical, and laboratory examinations. 3th ed. Walker HK, Hall WD, Hurst JW,eds. Boston, MA: Butterworths; 1990.
  2. Bohl DD, Shen MR, Kayupov E, Valle CJD. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty. 2016; 31(1):15-21. doi: 10.1016/j.arth.2015.08.028.
  3. Black CS, Goltz DE, Ryan SP, et al. The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty. J Arthroplasty. 2019;34(11):2594-2600. doi: 10.1016/j.arth.2019.05.060.
  4. Wilson JM, Lunati MP, Grabel ZJ, Staley CA, Schwartz AM, Schenker ML. Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient. J Orthop Trauma. 2019;33(6):284-291. doi: 10.1097/BOT.0000000000001448
  5. Sloan M, Sheth NP, Nelson CL. Readmission and reoperation following primary total knee arthroplasty in patients with obesity and hypoalbuminaemia. InOrthopaedic Proceedings 2019 Oct (Vol. 101, No. SUPP_11, pp. 15-15). The British Editorial Society of Bone & Joint Surgery.
  6. Rana AJ, Bozic KJ. Bundled payments in orthopaedics. Clin Orthop Relat Res 2015; 473(2):422. doi: 10.1007/s11999-014-3520-2.
  7. Lucas DJ, Haider A, Haut E, et al. Assessing readmission after general, vascular, and thoracic surgery using ACS-NSQIP. Ann Surg 2013; 258(3):430. doi: 10.1097/SLA.0b013e3182a18fcc.
  8. Lucas DJ, Pawlik TM. Readmission after surgery. Adv Surg 2014; 48:185. doi: 10.1016/j.yasu.2014.05.009.
  9. Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 2014; 472(1):188. doi: 10.1007/s11999-013-3034-3.
  10. Yuwen P, Chen W, Lv H, et al. Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC Surg. 2017; 17(1):7. doi: 10.1186/s12893-016-0186-6.
  11. Kishawi D, Schwarzman G, Mejia A, Hussain AK, Gonzalez MH. Low Preoperative Albumin Levels Predict Adverse Outcomes After Total Joint Arthroplasty. J Bone Joint Surg Am 2020;102(10):889-895. doi: 10.2106/JBJS.19.00511.
  12. Lu Y, Khazi ZM, Patel BH, et al. Big Data in Total Shoulder Arthroplasty. J Am Acad Orthop Surg. 2020; 28(14):e626-e632. doi: 10.5435/JAAOS-D-19-00173..
  13. Pugely AJ, Martin CT, Harwood J, Ong KL, Bozic KJ, Callaghan JJ. Database and Registry Research in Orthopaedic Surgery. J Bone Jt Surg. 2015; 97(15):1278-1287. doi: 10.2106/JBJS.N.01260.
The Archives of Bone and Joint Surgery
Volume 10, Issue 10
October 2022
Pages 858-862

  • Receive Date 16 September 2021
  • Accept Date 21 November 2021